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Prazosin cuts rate of drinking in patients with alcohol use disorder

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The α-1 adrenergic receptor antagonist prazosin appears to be an effective treatment for alcohol use disorder, according to a recent study.

“Prazosin holds promise as a harm-reduction pharmacologic treatment for alcohol use disorder and deserves further evaluation by independent research groups,” the authors said.

A total of 92 participants with alcohol use disorder but without post-traumatic stress disorder were randomized to receive prazosin or placebo in a 12-week double-blind study. Medication was titrated to a target dosing of 4 mg in morning and in the afternoon and 8 mg at bedtime by the end of week 2.

Medical management was the behavioural platform. Data on alcohol consumption were provided by participants daily. The authors assessed the impact of prazosin vs placebo on number of drinks per week, number of drinking days per week and number of heavy drinking days per week using generalized linear mixed-effects models.

Of the participants, 80 completed the titration and were included in the primary analyses. A significant association was seen between condition and week for both number of drinks and number of heavy drinking days. Participants in the prazosin condition had a greater reduction in the rate of drinking and the probability of heavy drinking compared with those in the placebo condition over time.

In addition, there was a higher incidence of drowsiness and oedema among participants in the prazosin vs the placebo condition.

“Current medications for alcohol use disorder do not target brain noradrenergic pathways. Theoretical and preclinical evidence suggests that noradrenergic circuits may be involved in alcohol reinforcement and relapse,” the authors said.

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